Publicly Funded Health Insurance and Equitable access for Internal Migrants in India: A Systematic Review of Barriers Under Ayushman Bharat-PM-JAY

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DOI: https://doi.org/10.5281/zenodo.18439374

Paramanand Rajwar and T Shukkoor (Department of Humanities and Social Sciences, Institute of Infrastructure Technology, Research and Management, Ahmedabad, Gujarat)

India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), the world’s largest government-funded health insurance scheme, has rapidly expanded coverage since 2018. However, internal migrants-an estimated 450600 million informal workers-remain excluded mainly due to non-portable benefits and intersecting social inequities. Following PRISMA 2020 guidelines, we searched Scopus, Web of Science, PubMed/Medline, Google Scholar, and ResearchGate (2010-March 2025) for peer-reviewed empirical studies on publicly funded health insurance, health equity, and internal migration in India. The reviewers screened records and assessed quality using the Mixed Methods Appraisal Tool. A thematic synthesis was conducted of the included studies. Of 2,847 records screened, 32 studies (17 quantitative, 10 qualitative, 5 mixed/review) were included. While the nominal enrolment of beneficiaries in AB-PMJAY has risen significantly, the program falls short of providing comprehensive financial protection, as many households that received insurance benefits from AB-PMJAY still incur out-of-pocket expenses and suffer catastrophic health costs. Internal migrants incur the most significant amount of financial hardship because they are unable to access health services due to documentation deficiencies, language barriers, inflexible job scheduling, discrimination, and other factors. Additionally, gender, caste, and informal employment play a significant role in increasing the rates of exclusion among migrant women and Scheduled Caste/Tribe populations. The overall conclusion of this study is that to provide equitable universal health coverage for all citizens in India, there will need to be a shift from the current hospital-centric, insurance-oriented model of healthcare to an improved public primary health care system with a functional interstate health care delivery system and services that are sensitive to the needs of migrant workers.